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非血缘脐血移植治疗儿童恶性和非恶性疾病的临床结局:中国多中心经验

Clinical outcomes of unrelated cord blood transplantation in children with malignant and non-malignant diseases: Multicenter experience in China.

作者信息

Tang Xiangfeng, Fang Jianpei, Yu Jie, Li Zhiguang, Chen Jing, Sun Xin, Zhu Yiping, Hu Shaoyan, Qin Maoquan, Tang Yongmin, Luan Zuo

机构信息

Navy General Hospital, Beijing, China.

Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.

出版信息

Pediatr Transplant. 2018 Feb;22(1). doi: 10.1111/petr.13090. Epub 2017 Dec 14.

Abstract

This multicenter retrospective study included 184 children with malignant and non-malignant diseases who underwent UCBT between January 1998 and August 2012. The malignant disease group included 101 children with ALL, AML, CML, JMML, and MDS, and the non-malignant disease group included 83 children with PID, β-thalassemia, IMD BMF, and HLH. The median duration to neutrophil and platelet engraftment was 16 and 35 days in the malignant disease group vs 15 and 38 days in the non-malignant disease group. The cumulative incidence of grade II-IV aGVHD and cGVHD was 25.6% and 13.5% in the malignant disease group vs 19.7% and 11.1% in the non-malignant disease group, respectively. The median duration and cumulative incidence of neutrophil and platelet engraftment, and the cumulative incidence of grade II-IV aGVHD and cGVHD were similar between the two groups. Of the 184 pediatric patients, 114 patients survived during a median follow-up period of 14 months (range 4-138). The 5-year OS and DFS were not statistically different between the two groups (56.3% and 46.1% in malignant disease group vs 68.5% and 52.8% in non-malignant disease group). The above results indicate that UCB is a viable source for HSCT for children with malignant or non-malignant diseases, especially in urgent cases.

摘要

这项多中心回顾性研究纳入了1998年1月至2012年8月期间接受脐血移植(UCBT)的184例患有恶性和非恶性疾病的儿童。恶性疾病组包括101例患有急性淋巴细胞白血病(ALL)、急性髓系白血病(AML)、慢性髓系白血病(CML)、幼年型粒单核细胞白血病(JMML)和骨髓增生异常综合征(MDS)的儿童,非恶性疾病组包括83例患有原发性免疫缺陷病(PID)、β地中海贫血、重症联合免疫缺陷病(IMD)、噬血细胞性淋巴组织细胞增生症(HLH)的儿童。恶性疾病组中性粒细胞和血小板植入的中位时间分别为16天和35天,而非恶性疾病组分别为15天和38天。恶性疾病组Ⅱ-Ⅳ级急性移植物抗宿主病(aGVHD)和慢性移植物抗宿主病(cGVHD)的累积发生率分别为25.6%和13.5%,而非恶性疾病组分别为19.7%和11.1%。两组中性粒细胞和血小板植入的中位时间、累积发生率以及Ⅱ-Ⅳ级aGVHD和cGVHD的累积发生率相似。在184例儿科患者中,114例患者在中位随访期14个月(范围4-138个月)内存活。两组的5年总生存率(OS)和无病生存率(DFS)无统计学差异(恶性疾病组为56.3%和46.1%,非恶性疾病组为68.5%和52.8%)。上述结果表明,脐血是患有恶性或非恶性疾病儿童进行造血干细胞移植(HSCT)的可行来源,尤其是在紧急情况下。

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